Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 30283 | SC |
N | 208000000X | Pediatrician | 63960 | GA |
N | 208000000X | Pediatrician | N8989 | TX |
Y | 2080P0205X | Pediatric Endocrinologist | M13504 | ID |
N | 2080P0205X | Pediatric Endocrinologist | N8989 | TX |
NPI | 1154528727 |
---|---|
Provider Name | Dr. Joshua Michael Smith |
First Address | Idaho Falls, ID 83404-7596 |
Second Address | Idaho Falls, ID 83404-7596 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 02/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1154528727 | (05) | ID |
312219409 | (05) | TX |
312219410 | (05) | TX |